Slow rabbits and fast wolves

Every morning the hungry wolf wakes up knowing that if he's not faster than the slowest rabbit, he won't make it through the day. Every morning the rabbit wakes up knowing that if he's not faster than the fastest wolf, he's not going to make it through the day, either.

This little fable kept popping into my head as I sat in on the coding and reimbursement seminar today. Lest anyone get the wrong idea, learning how to increase our reimbursements is not why we go to these things, even though that's nice should it ever happen. We go to these seminars to stay out of jail.

Trying to stay off the radar of the Medicare reimbursement and fraud prevention people is like driving along a tortuous road on a dark and stormy night in a car with no speedometer and where the cops change the speed limit every few days but it doesn't matter because they don't post the speed limit anywhere you can see it, and if you don't get to your destination very quickly a tiny little kitten will die a slow and miserable death.

The analogy might seem a bit overwrought, but to the doctor who's trying to be a good citizen, stay out of jail, and pay his malpractice premiums, it's actually understated.

I won't bore you with the details, but the consultants are warning us about some pretty ugly stuff coming along. Obesity is a growing problem in this country, and the surgeons performing gastric bypasses are seeing their practices burst at the seams.

Insurance companies are not happy pouring the feed into the trough, and their solution is very simple: put a lifetime cap on payments they'll make for bariatric patients.

My first reaction was a blase "Boy, that's too bad" until the consultant mentioned that in order to make the cap stick the insurance companies intend to limit what they'll pay for all digestive disorders.

"How can they get away with that?" Beats me, but with assets greater than most countries in the world, the insurance companies will find a way.

This means that gastroenterologists may simply not allow bariatric patients into their practice. And that would be a shame.

There are times that this old rabbit thinks his knees are getting just too sore.